View
217
Download
0
Category
Preview:
Citation preview
David Makumi (1)
Elizabeth Abongo (2) Lawrence Gichini (3)
1, 2,3, The Aga Khan University Hospital, Nairobi.
Objective.
Describe a low cost model of
cancer control by availing specific
services in shopping malls and community
centers.
Background: Kenya Some Health indicators
Population 39 million Life expectancy at birth:
Male: 52Female: 55
Total expenditure on health as % of GDP 4.3%
Risk of getting cancer before age 75: 14.1%
Risk of dying from Cancer before age 75: 12%
Medical oncologists: 3 Radiation Oncologists <20
Source: WHO Statistics 2010 Globocan 2008
Cancer background: I
Double burden of Non communicable and Communicable diseases in compounded by poor access to healthcare.
Breast, Cervical, GIT cancer are top two cancers in women, H&N, Prostate and GI top in Men
80% of Women present with stage 3 or 4 disease.
Nairobi Cancer Registry 2006
Reasons for late diagnosis.
Lack of knowledge by the population about the symptoms.
fear, denial and a fatalistic attitude towards cancer.
Belief in traditional medicines.Lack of Access to Screening:
=Affordability. =Acceptability. =Availability.
Nairobi Cancer Registry 2006
Cancer: background
Justification
Problem of large-scale ill health in rural and urban Kenya not primarily a technical-medical issue.
Key requirement to meeting the health care needs of urban dwellers is not just newer medical technologies, but a culturally acceptable cost effective innovative cancer control .
Why community centres? = Devoid of the impersonal, intimidating hospital
atmosphere =Provide a more women friendly environment. =Clients are in control
Material & Methods.
To be successful, the screening program used a public health model
Aimed at Good population coverage for screening.
Respect for the local customs, dignity, privacy and autonomy of the women and Involved grass root women right from the planning stages.
All women had clinical breast examination and were taught self breast examination during the encounter with a health care provider and given essential information on risk reduction.
Self administered questionnaire on her breast health and risk assessment.
Data on clinical findings entered and analyzed using SPSS.
PUBLICITY •Media•Fliers•Churches•communities
INCENTIVES.
•Discounted breast imaging / pathology rates.
•FREE C.B.E.•One to One encounter with health providers• cancer information •Education & information material
FOLLOW-UP
REFFERALS
Need for Cancer Control
Interventions
Model
Findings This is an ongoing program. 8000+
women have been screened through clinical breast examinations in retail outlets over the last 24 months..
15% of the women presented with breast problems such as fixed lumps with lymph nodes and bloody nipple discharge.
20% have done mammograms which they would not have otherwise done.
Other health concerns are also addressed.
The project is ongoing.
Age distribution
Age (years)
65.060.055.050.045.040.035.030.025.020.015.0
160
140
120
100
80
60
40
20
0
Std. Dev = 9.59
Mean = 31.4
N = 471.00
FEMALE BREAST AND CERVICAL CANCER:
0
10
20
30
40
50
60
0-4 5 to 9 10 to14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-85
AGE- GROUPS
NO
. OF
CA
SES
Breast
Cervix uteri
Have you ever had a nurse or a doctor examine your breast?
Have you ever had a Nurse or doctor examine your breast
Have you ever had a Nurse or doctor examine your breast
NOYES
Pe
rce
nt
80
60
40
20
0
70% have Never had a CBE.
? Lack of awareness on both HCP & Client.
? Failure of health professionals.
Use of hormonal contraceptive /HRT
NOYES
Co
un
t150
140
130
120
110
100
90
80
Regularly perform a
YES
NO
Discussion Need for health planners, policy makers, and
other stakeholders to engage and involve communities in designing new and innovative cost effective health care delivery models is Urgent.
Populations buy into Cancer Control interventions when implemented at community level.
Clinical Breast Examination are a suitable option for countries in economic transition, where incidence rates are on the increase but limited resources do not permit screening by mammography
Conclusion
Urban areas face a myriad of health challenges from rapid population growth, pollution, unplanned settlements, and an increase in both communicable and non communicable diseases.
A model of partnering with the community institutions in implementing cancer control interventions will help address the unfolding cancer epidemic at community level
This is where effective cancer control starts.
Thank you
References Baxter, N. (2001). Canadian Task Force on Preventive Health Care.: Preventive health care, 2001 update:
should women be routinely taught breast self-examination to screen for breast cancer? Canadian Medical Association Journal, 164 (13): 1837-46.
Carlson, R.W., Anderson, B.O., Chopra, R., Eniu, A.E., & Love, RR. (2003). Treatment of breast cancer in countries with limited resources. The Breast Journal, 9(s2), S67–S74.
CIA. (2008). Kenya, The World Fact Book. Retrieved February 20, 2008, from https://www.cia.gov/library/publications/the-world-factbook/geos/ke.html.
Disease Control Priorities Project (DCPP). (2007). Controlling Cancer in Developing Countries Retrieved April 10, 2008, from http://dcp2.org/file/79/DCPP-Cancer.pdf
Gachenge, B. (2007, November 7) Breast Cancer War Undermined by Lack of Radiologists. The Daily Nation.
Harvey, B.J., Miller, A.B., Baines, C.J., & Corey, P.N. (1997). Effect of breast self-examination techniques on the risk of death from breast cancer. Canadian Medical Association Journal, 157 (9): 1205-12.
Pezzatini M., Marino, G., Conte, S., & Catracchia, V. (2007) Oncology: a forgotten territory in Africa. Annals of Oncology, 18: 2046-2047.
Remennick, L. (2006). The Challenge of Early Breast Cancer Detection among Immigrant and Minority Women in Multicultural Societies. The Breast Journal, 12 (s1), S103–S110
Republic of Kenya Ministry of Health. (2006). Health Facilities by District. Retrieved March 31, 2008, from http://www.health.go.ke/HMIS.htm
Shyyan, R., Masood, S., Badwe, R.A., Errico, K.M., Liberman, L., Ozmen, V., et al. (2006). Breast Cancer in Limited-Resource Countries: Diagnosis and Pathology. The Breast Journal, 12(s1), S27–S37
Smith, R., Caleffi, M., Ute-Susann, A., Chen, T.H.H., Duffy, S.W., Francheschi, D., et al. (2006) Breast Cancer in Limited-Resource Countries: Early Detection and Access to Care. The Breast Journal, 12(s1), S16-S26
World Health Organization. (2002). National Cancer Control Programmes: Policies and Managerial Guidelines. Geneva, Switzerland: WHO
World Health Organization. (2006). Country Health System Fact Sheet 2006, Kenya. Retrieved Sept 10, 2009, from http://www.afro.who.int/home/countries/fact_sheets/kenya.pdf
Zotov V., & Shyyan R. (2003) Introduction of breast cancer screening in Chernihiv Oblast in the Ukraine: report of a PATH breast cancer assistance program experience. The Breast Journal., 9(s2), S75–S80.
http://www.who.int/whosis/mort/profiles/ accessed 5th April 2010 Nairobi cancer registry, 2006 Report
Recommended